• Open Access

Which strategies reduce breast cancer mortality most?

Collaborative Modeling of Optimal Screening, Treatment, and Obesity Prevention


  • Prepared under contract from the American Cancer Society Project #NHSURVGDO.

  • We thank the Breast Cancer Surveillance Consortium (BCSC) for data provided for this study. BCSC data collection was supported by NCI cooperative agreements U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, and HHSN261201100031C. The collection of cancer data was also supported by public health departments and cancer registries. For a full description of these sources, please see http://www.breastscreening.cancer.gov/work/acknowledgement.html. A list of the BCSC investigators and procedures for requesting data are provided at http://breastscreening.cancer.gov/.

  • Model results are the sole responsibility of the authors and do not reflect the views of the funding agencies.



US breast cancer mortality is declining, but thousands of women still die each year.


Two established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. The models use common national data on incidence and obesity prevalence, competing causes of death, mammography characteristics, treatment effects, and survival/cure. Parameters are modified based on obesity (defined as BMI ≥ 30 kg/m2). Outcomes are presented for the year 2025 among women aged 25+ and include numbers of cases, deaths, mammograms and false-positives; age-adjusted incidence and mortality; breast cancer mortality reduction and deaths averted; and probability of dying of breast cancer.


If current patterns continue, the models project that there would be about 50,100-57,400 (range across models) annual breast cancer deaths in 2025. If 90% of women were screened annually from ages 40 to 54 and biennially from ages 55 to 99 (or death), then 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), then 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. If 100% received screening plus indicated therapy, there would be 18,100-20,400 fewer deaths. Eliminating obesity yields 3300-5700 fewer breast cancer deaths versus continuation of current obesity levels.


Maximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention. Cancer 2013;119:2541–2548. © 2013 American Cancer Society.